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J-800-356-1561 Commissione/' JON . John R. Guhl Di/'eclo/' MEDICAID COMMUNICATION NO. 09-10 TO: Comity Welfare Agency Directors ISS Area Supervisors Sl1BJECT: DATE: May 1, 2009 Revised PA-4 Form As you are aware, the New Jersey Department of Health and Senior Services' "Certification of Need for Nursing Care in Facility Other than General Hospital" PA-4 fonn is a document that is completed by a physicia..'1 for those Medicaid applicants who are in need of skilled nursing home care or.

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